Kawasaki Syndrome: Association With the Application of Rug Shampoo

Patriarca, P. A.; Morens, DavidM.; Rogers, M.; Schonberger, LawrenceB; Kaminski, RoseM; Burns, J. B.; Glode, MaryP

doi:10.1016/s0140-6736(82)90660-2

Cited by 74 publications

(16 citation statements)

References 11 publications

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“…[38][39][40][41][42][43][44] Other factors reportedly associated with KD include eczema, 45 humidifier use, 44 and residence near a standing body of water. 46 Recent epidemiological studies have pointed to some potential environmental risk factors for KD.…”

Section: Applying Classification Of Recommendations and Level Of Evmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,788

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Applying Classification Of Recommendations and Level Of Evmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,788

4,124

View full text Add to dashboard Cite

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“…There have been 3 outbreaks in Colorado investigated by the Centers for Disease Control and Prevention in the last 20 years, and physicians throughout the state have aided in these investigations. 3,8,9 The Children's Hospital (Denver) is a large tertiary care pediatric hospital, and our infectious-disease group routinely takes calls from providers throughout the state for questions and referrals related to KS. Questions regarding KS are one of our most common telephone inquiries, indicating that KS is often considered in the differential diagnosis of febrile children.…”

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

2005

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ABSTRACT.Objective. Most pediatric providers in Colorado are familiar with Kawasaki syndrome (KS). However, in a recent outbreak, 30% of cases were diagnosed after illness day 10. We hypothesized that these children saw providers who were not familiar with KS, were given antibiotics for other diagnoses that delayed identification, had access-to-care issues, or presented atypically.Methods. A retrospective chart review of 106 consecutive KS cases seen at the Children's Hospital in Denver during 1994 -2000 was conducted.Results. Twenty-five of 106 children (23.6%) were diagnosed after day 10 of illness (delayed-diagnosis group [DDG]), and these 25 cases were compared with 81 cases diagnosed on or before day 10 (early-diagnosis group [EDG]). There were no differences between patients in the DDG and EDG in age, gender, number of visits, specialty of the primary care physician, time to the first medical visit, number of antibiotics received, coronary artery abnormalities, white blood cell count, or erythrocyte sedimentation rate. Patients in the DDG had significantly more days of fever, rash, red eyes, and oral changes. A platelet count of >450 000/mm 3 occurred more often in the DDG (56%) than the EDG (30%). After additional analysis, patients in the EDG had close clustering of symptom onset in the first few days of illness, but patients in the DDG had onset of symptoms scattered over 9 days. Patients in the DDG were 2.8 times more likely to have coronary artery aneurysms than patients in the EDG (DDG: 24%; EDG: 8.6%).Conclusions. Diagnosis after the 10th day of illness was not linked to type of medical provider, number of antibiotics received, or number of physician visits. Patients in the DDG exhibited the typical features of KS, but the onset of their symptoms was dispersed over time as opposed to the close clustering of symptoms in the EDG. Because coronary artery aneurysms occurred significantly more often in the patients in the DDG, more education is needed to teach health care providers to have a high index of suspicion for KS in young children presenting with fever/rash illnesses.

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“…During several outbreaks, case control studies have been performed to attempt to identify risk factors for Kawasaki disease. Recent shampooing of rugs in the household, proximity to water, and antecedent infections have been proposed but the studies are conflicting [20,23,24,27,35,57,75,78].…”

Section: Epidemiology and Etiologymentioning

confidence: 99%

Epidemiology, Etiology, and Management of Kawasaki Disease: State of the Art

Laupland

Davies

1999

Pediatr Cardiol

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Since its first description in Japan 30 years ago, Kawasaki disease has been reported worldwide. Although an infectious etiology is suspected based on the epidemiology and clinical features, a causative agent has not been identified. The majority of the morbidity and mortality associated with this condition is attributable to the development of coronary artery aneurysms. Treatment during the acute phase with intravenous immunoglobulin and acetylsalicylic acid results in significant reductions in coronary complications. The long-term management of patients with persistent coronary abnormalities is less well-defined. This article reviews the epidemiology, possible etiologies, and management of Kawasaki disease.

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Kawasaki Syndrome: Association With the Application of Rug Shampoo

Cited by 74 publications

References 11 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

Epidemiology, Etiology, and Management of Kawasaki Disease: State of the Art

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